Chief Inspector of Hospitals publishes his findings on Hull and East Yorkshire Hospitals NHS Trust

Chief Inspector of
Hospitals publishes his findings on Hull and East Yorkshire Hospitals NHS
Trust

England's Chief Inspector of
Hospitals has published his first report on the quality of services provided by
Hull and East Yorkshire Hospitals NHS Trust.

Both the Hull Royal Infirmary
and Castle Hill Hospital at Cottingham have been rated as Requiring Improvement
following an inspection in February under the new inspection regime introduced
by the Care Quality Commission to provide a much more detailed picture of care
in hospitals than ever before. A full copy of the report can be found
at:

While end of life care, critical
care and maternity and family planning services were rated Good – the
inspection team have concluded that all other services at the two hospitals
require improvement.

An inspection team of 45 people
which included doctors, nurses and midwives, and hospital managers, trained
members of the public, a variety of specialists, CQC inspectors and analysts
spent three days at the hospitals in February. They also visited both hospitals
unannounced over two days.

Inspectors found that both
hospitals were facing significant challenges due to the shortage of staff and
insufficient capacity to deal with the increasing numbers of admissions,
particularly patients referred to the hospital as an
emergency.

The shortage of nursing and
medical staff, particularly junior doctors, was affecting the care patients
received, leading to delays in assessment and treatment. Staffing levels and
skill mix did not always meet national guidance, although the trust board had
agreed to invest in recruiting more nurses, and was in the process of
recruiting for doctors’ posts.

At the Hull Royal Infirmary, the
accident and emergency department did not have the capacity in terms of
facilities and staffing to deal with the numbers of patients attending. There
was a lack of appropriate senior clinicians and the children’s accident
and emergency department could not provide a dedicated 24-hour service. While a
refurbishment programme due to be completed this summer, would increase the
size and capacity of the department, in the meantime patients faced long waits,
sometimes on trolleys in corridors.

Inspectors acknowledged the
trust had a clear vision for the future, with a number of new initiatives to
engage staff and patients, and involve staff in the drive to improve services.
While the incident reporting system had recently been strengthened, not all
incidents were being reported and learning from these was not consistently
shared across the trust.

The trust was found to be
improving the way it engaged with the public. Among other improvements noted by
the inspectors was the introduction of a Pioneer team which allowed staff to
develop solutions which would drive improvement throughout the organisation.
The end of life team too had developed a package of care to ensure that
relatives and carers received the support they needed.

The Care Quality Commission has
identified 20 areas where the trust must improve, including:

The trust must ensure that there
are enough suitably qualified and experienced staff on duty, particularly at
night and weekends.

The trust must investigate why
some staff feel that they bullied, or feel pressure to undertake additional
hours, putting the need to meet targets above patient care.

Incident reporting must be
reviewed to ensure that staff report incidents appropriately and in a timely
manner and ensure that staff receive feedback from incidents.

The patient pathway into the
hospital must be reviewed particularly through the accident and emergency
department, to ensure that patients are assessed and treated appropriately to
meet their needs.

Patients must have improved
access to hospital appointments, with the cancellation of outpatient clinics
kept to a minimum.

Patients’ assessment and
treatment must be based on best practice guidelines and delivered at the right
time to meet those needs.

We know that Hull and East
Yorkshire Hospitals NHS Trust has been facing significant challenges with the
increasing numbers of patients coming to hospital in emergency. Although staff
have been working hard to meet patients’ needs, this has been a struggle
at times, with staff shortages which have been was felt across a range of
services.

It of particular concern that
the shortage of junior doctors was impacting on the care patients received,
leading to delays in assessment and treatment. We heard that many patients
found that they were moved, sometimes more than once, within the hospital and
between hospitals, often through the night.

We know that a new A and E
department is due to open in August and it is encouraging that the trust has
set its sights on greater involvement of staff, the public and the wider
community in its organisational development. Some of these initiatives are
still in their infancy - and the challenge now is to ensure that all the
trust's staff are properly engaged.

ENDS

For media enquiries,
call the CQC press office on 020 7448 9401 during office hours or out of hours
on 07917 232 143.

For general enquiries,
call 03000 61 61 61.

Notes to
editors

The Chief Inspector of
Hospitals, Professor Sir Mike Richards, is leading significantly larger
inspection teams than before, headed up by clinical and other experts including
trained members of the public. By the end of 2015, CQC will have inspected all
acute NHS Trusts in the country with its new inspection model. Whenever CQC
inspects it will always ask the following five questions of every service: Is
it safe? Is it effective? Is it caring? Is it responsive to people’s
needs? Is it well-led?

This report describes our
judgment of the overall quality of care provided by this trust. It is based on
a combination of what we found when we inspected, information from our
‘Intelligent Monitoring’ system, and information given to us from
patients, the public and other organisations

The Care Quality Commission has
already presented its findings to a local Quality Summit, including NHS
commissioners, providers, regulators and other public bodies. The purpose of
the Quality Summit is to develop a plan of action and recommendations based on
the inspection team’s findings.